Arizona Chiropractic Society eNewsletter
Providing leadership, advocacy and resources that promote
professional excellence and quality patient care in chiropractic
Statewide Non-Profit
Chiropractic Association
May 2008
In This Issue
Special Thanks to Members of the ACS President's Club
Huge Overflow Crowd of ACS Doctors...and Patients Comes to Capitol to...Support ACS Copay Bill
Record Keeping as The Chiropractic Board
ACS Victory Checklist.
There is Only One Way to Stay on Top...of Current Events in Arizona
Why Don't Chiropractors...See Injured Workers?
Therapy Provider, Spinedex Physical...Therapy USA Inc., Files Suit
ACS Presses ADOI on...Humana and AWHN
ACS Launching Online
Find-A-Doc New Patient
Referral Search Engine

ACS is launching an online Find-A-Doc search engine on its webpage for members. This will result in new patient referrals for members since the ACS webpage appears high on the list when Internet searches are done for Arizona chiropractors or chiropractic. It will usually take only one referral per year to more than cover the cost of annual dues. To join ACS and be listed on this highly valuable referral search engine, go to and complete an application. ACS is ready to help you today!

    Attention members: If you have not yet done so, send ACS a note stating that you would like to be listed on the Find-A-Doc search engine. Don't miss out on this valuable new patient opportunity! We have not yet heard from all of you. Send us a note today and get listed!
Special Thanks to Members of the ACS President's Club

Many thanks to our visionary members who contribute $279 per month to help ACS work hard for chiropractic progress. These doctors are premier members of the ACS President's Club. Special thanks to Drs. Rob van Zweeden, William Zeiler, Leo Rayburn, Trever Penny, Shaun and Nikki Miglore, E.J. Strandlund, Randall Widmaier, Gregg Friedman, Angelo Pisano, Tracy Peruch, Jeff Raiffie, Randy Leraaen, Jeff Rebarcak, Josh and Jenna Haggard, and an anonymous DC. Please join these leaders today! ACS can do so much more for chiropractic with additional support!

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3515 E. Carol Avenue
Phoenix, AZ 85028
VOICE 602.368.9496
FAX 602.368.8954
Dear Arizona Chiropractor and other interested party,

This is your May 2008 ACS email newsletter. Please forward this to any of your fellow Arizona chiropractors or anyone else who would benefit from the information here. Also, please feel free to contact us with any questions or, if you wish to no longer receive these important communications, click the unsubscribe link at the bottom.

Through out this eNewsletter you'll find various sponsors for our efforts. Please support our sponsors and be sure to tell them that you saw their ad in the ACS eNewsletter.

Warm regards,
Alan M. Immerman, D.C.
President & Executive Director

Huge Overflow Crowd of ACS Doctors
and Patients Comes to Capitol to
Support ACS Copay Bill
A huge overflow crowd of more than one hundred ACS doctors and their patients came to the Capitol on April 2, 2008 to support the ACS copay/deductible legislation. This required opening a second hearing room that quickly filled to capacity. The entire first floor of the House was packed with chiropractors and patients for hours. Senator Linda Gray, ACS lobbyist Debra Brimhall Pearson and ACS President Dr. Immerman gave the enthused attendees specific instructions on who to meet and what to say that day and after to advance the copay bill. A political movement was re-energized and reborn, perhaps in response to this ACS notice paraphrased from Patrick Henry "Give me Healthcare Liberty, or Give me Death!" Members heard the call and descended en masse at the Capitol.

The impact of having so many people show support for this bill was enormous. Legislators spoke of the large numbers for weeks. This greatly added to the overall impetus to pass this legislation to reduce copays and deductibles for chiropractic services. ACS will not give up until this goal is achieved.

SB 1048 did not turn out to be the "vehicle" to carry the copay language for ACS and Sen. Gray. As of press time, ACS and Sen. Gray are actively working to amend a different bill with the copay language. ACS will continue to try to amend our language onto another bill until we either succeed or the session adjourns in June.

We will not give up until they turn the lights out. We keep working long after all the high-priced corporate lobbyists have given up and gone home for the session, having told their clients all  hope is lost for the year. If we do not succeed this session, we will immediately begin to plan for next. We will never give up until we achieve our goal of full insurance equality. That has been the central goal of ACS since its inception in 1991, along with securing a fair Chiropractic Board. We have achieved most of the goal with the passage of four earlier insurance equality laws, posted at Now, we just need to pass the copay bill to close the newest loophole exploited by the insurance companies. We will succeed.

ACS has also launched a parallel aggressive "Plan B" to achieve non-discriminatory copayments and deductibles by convincing the Arizona Department of Insurance (ADOI) to correctly interpret and enforce the insurance equality law, ARS 20-461(A) 17 and 20-461(B). This law was properly enforced from the time ACS passed it in 1990, until 1995 when a new ADOI Director changed positions. Plan B involves DCs filing complaints with ADOI on behalf of patients with discriminatory copays and deductibles, demanding that ADOI halt this illegal practice.

ADOI has recently confirmed that the existing law actually prohibits copayments and deductibles which discriminate against the usual and customary treatment procedures of a chiropractor. ACS has this in writing from ADOI dated April, 2008. Now, ACS doctors with their complaints are demanding that ADOI enforce this law and end the discrimination. Go to the ACS webpage to download the letter needed to send to ADOI: If you want an end to this discriminatory practice, start filing scores of complaints immediately. Many ACS members have filed hundreds.

All this leaves ACS with a major open question for ADOI: Why, after all this time, since ADOI has determined that discriminatory copays and deductibles for chiropractic treatments are illegal; and, considering ADOI's knowledge that this practice is universal in Arizona; why has ADOI not taken action to halt this illegal activity? Isn't that why ADOI exists, to enforce state insurance laws? Why has ADOI sat idly by while the entire insurance industry has flagrantly violated the law for years? Please explain.

Arizona legislators and ADOI leadership read this newsletter, along with the entire chiropractic community. ACS will print the ADOI response in the next issue. The chiropractic profession is truly puzzled and would like an answer.

In addition, ACS has been notified that Senator Linda Gray and other legislators will be asking Arizona Attorney General Terry Goddard to enforce this law the way it was written and intended. ACS will supply a copy of Sen. Gray's letter to the AG as soon as we receive it.

You can get breaking news by signing up for the ACS e-newsletter at Just go to the home page, upper left corner, enter your email address, and strike enter. You can speed up our efforts to achieve insurance equality and a fair Chiropractic Board by joining ACS if you are not already a member. Just go to our webpage for membership information.


Our sponsors are very special to ACS. They help make it possible to bring our written and electronic information to you. They help pay for the ink and postage! Won't you please consider them when you need a service or product? We obviously wouldn't do business with them if we didn't think they were good folks. Please be sure to give them a look. They are supporting your profession and deserve your gratitude for that.

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Record Keeping as Mandated
by The Chiropractic Board

The rule for record keeping in Arizona states: "The notes for each patient visit shall include the patient's name, the date of service, the chiropractic physician's findings, all services rendered, and the name or initials of the chiropractic physician who provided services to the patient." The current Board has radically expanded the requirement beyond the letter of the rule.

Compare the requirements of the Board rule with the following standard now imposed. When a doctor gets in trouble for record keeping violations, the doctor is ordered to take classes in record keeping. Then, the Board may order audits. The following is an example of what a leading Board auditor told a state DC was required by the Board.

ACS also has a copy of the auditor's entire written protocol for record keeping. The Board, apparently, still remains more interested in entrapping than educating. If this were not true, the Board would disseminate its auditor's protocol for record keeping. There is no clearer guide. ACS members may contact ACS for a copy.

"SUBJECTIVE: On this visit, Ms. Smith (fictitious name) stated that she was experiencing constant moderate left upper neck pain which was generally achy but occasionally sharp in character. From the left upper neck, there was radiation of pain to her headaches. This began several days ago after an auto accident. She was also experiencing upper mid-back pain. She further reported having left posterior upper shoulder pain. She reported having right upper neck pain. Additionally, she described having right sacroiliac pain. The symptoms were generally worse with use, activities of daily living and bending and twisting. The symptoms were overall better with lying down and rest. Her score on the zero to ten scale today was a 7."

The next visit, the following subjective entry was required: "Ms. Smith reports feeling no significant difference in her symptoms since her last visit. Today, Ms. Smith described having left upper neck pain. She also described experiencing right posterior upper shoulder pain. She was also experiencing right lower back pain. She further reported having left sacroiliac pain. Today, her zero to ten score was a 6."

"OBJECTIVE: Kemp's test and Milgram were positive bilaterally. On palpation, moderate spasm and tenderness were noted in the cervico-thoracic region, the lumbo-sacral region and the thoraco-lumbar. All active cervical ranges of motion were moderately restricted by pain. All active thoraco-lumbar ranges of motion were moderately restricted by pain. On spinal evaluation, subluxations were noted at the right occiput, C1, C2, C5, C6, T2, T3, T8, L3, L4, L5, the right sacroiliac joint, the left sacroiliac joint, the sacrum and the right ilium."

On a return visit a few days later, this note was required: "The objective findings are unchanged since the last visit. All active cervical ranges of motion were mildly restricted by pain. All active thoraco-lumbar ranges of motion were mildly restricted by pain."

"ASSESSMENT: The current care is primarily corrective in nature and the overall prognosis is excellent." Then, a few days later, "She is making acceptable progress toward resolution of the chief complaint."

"PLAN: The goals of care are to alleviate her symptoms, eliminate her regional muscle spasm and increase active ROM of the cervical spine. Additional goals of care are to reduce the regional tenderness, return Ms. Smith to normal daily activities without pain and return all of her active, passive and resisted ranges of motion back to normal levels. A further goal of care is to clear all joint restrictions. The treatment schedule will be a visit PRN. The treatment schedule will be daily for a few visits and then reevaluate. The purpose of care is to reduce her pain, reduce joint fixations and reduce inflammation. Additionally, care will be provided to increase her overall flexibility. Manipulation consisted of diversified maneuvers to C1, C2, C5, C6, T2, T3, T8, L3, L4, L5, the right sacroiliac joint, the left sacroiliac joint, the right occiput, the sacrum and the right ilium. Myofascial release was performed by the doctor to her cervico-thoracic region, lumbo-sacral region and thoraco-lumbar for 10 minutes. She tolerated today's treatment well and reported feeling about the same afterward. She is to return in 1 day. While at home, I have instructed Ms. Smith to ice the area for 15 minutes PRN. We discussed that post treatment soreness is to be expected. Ms. Smith indicated understanding of the items discussed."

It is almost impossible to write notes of this length and see more than 25 patient visits per day. Some doctors have resorted to the use of computer programs. The Board, however, appears to frown on the use of such programs since they may not sufficiently individualize each patient, each subjective complaint, each objective finding, each exam, and every other notation. Some doctors have reported that the Board only accepts the notes of those DCs with advanced college degrees in creative writing! The Board has made it impossible to run a volume practice - perhaps this was its intent from the beginning in its quest to remake the profession. ACS has noted many other ways this Board has attempted to steer chiropractic in a "medipractic" direction over the years.

ACS is a "live and let live" organization. We embrace and support traditional subluxation-based chiropractic, and also broad-scope medically oriented and orthopedic chiropractic. As long as you practice with honesty, good ethics, morals, and fine chiropractic skills, we have no preference as to which type of chiropractic you choose. That is a private matter between you and your patients. Unfortunately, the current Chiropractic Board feels quite differently, and is trying to force all chiropractors to practice in the medipractic mode. This Board is trying to eliminate subluxation-based chiropractic in Arizona. Only ACS stands in its way. ACS represents both ACA and ICA doctors in Arizona.

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ACS Victory Checklist

Only ACS has a grassroots political program. ACS constantly alerts its hundreds of members and non-members when key legislators need to be contacted by patients and doctors. As a result, these legislators receive tons of emails and phone calls, and hundreds of patients and doctors show up to legislative hearings. Without this potent grassroots political program, there would be no hope of the copay/deductible bill passing.

Only ACS has confronted the Chiropractic Board over its gross mistreatment of state chiropractors. ACS is completely independent of the Board and does not have an office across the hall. Nor does ACS support the current Board DCs. If you want Board reform and replacement, ACS is your organization. As a direct result of ACS, the Board no longer disciplines licenses for record keeping violations. Doctors are only ordered to take CE classes with no black marks placed on their licenses.

Only ACS has a full-time veteran licensed DC at your service to answer all of your questions on any chiropractic issue. Other organizations have paid staff that cannot match any DC's expertise and experience.

Only ACS has developed written powerful specific position papers to convince legislators to support the chiropractic copay/deductible bill. These papers are printed in full at Legislative page. Without these documents, the copay bill would never pass. Legislators must be convinced with facts and logic.

Only because of ACS' intervention are CAs allowed to do more than just a few passive modalities. The CA rules were amended because of ACS to include the words "and is not limited to . . ." Without ACS, you would have been required to personally administer all active rehab.
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There is Only One Way to Stay on Top
of Current Events in Arizona -- Sign Up for the Free ACS E-Newsletter at

There is only one way to really know what is going on in the Arizona chiropractic community: sign up for the free monthly ACS e-newsletter at Just go to the homepage at the upper left corner, enter your email address, and strike enter. Then you will be in the loop. Here is how valuable this will be for you. In last month's mailed newsletter, ACS announced that ACS and Senator Gray had revived the copay/deductible bill as SB 1048. By the time you received the newsletter in the mail, ACS had already abandoned SB 1048 as a "vehicle" to carry our copay language, and decided on a new bill. Therefore, because the legislative process moves so quickly, the printed information you read was outdated. Recipients of the e-newsletter received the updated information about the new strategy. Now you can also by signing up for the ACS e-newsletter. Do it today!   

Also, ACS is pleased to announce that Arizona Chiropractic Board meeting minutes are now posted on the ACS Chiro Board webpage for all to see. Now you can finally learn what the Board is doing every month at its meetings. ACS wants the profession to see exactly how the Board is behaving.
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Why Don't Chiropractors
See Injured Workers?

Why don't chiropractors see injured workers in Arizona? When was the last time you saw a patient that was injured at the workplace? When was the last time your office filled out an Industrial Commission "pink form" and billed a workers' comp insurer like State Comp Fund?

If your answer is typical of that heard from the vast majority, you have not treated an injured worker for years. Doctors licensed before 1990 remember treating workers covered by State Compensation Fund, but since that time the flow has slowed to near zero. What happened?

ACS, the association in this state that watches out for your economic survival like a trade union, has now completed its investigation, and is ready to reveal the results. We have spoken with many veteran DCs, legislators and attorneys. Here are the facts.

In Arizona, self-insured employers are permitted to tell their injured employees where to go to get care after injuries. Insured employers are not allowed to direct care. The largest workers' compensation insurance company, State Compensation Fund (SCF), has told its insured clients, the employers, that if they will convince their injured workers to go to preferred providers, then SCF will discount the insurance premiums. Therefore, the employers "persuade" their employees to go where they want them to go. They do not "direct" care, they just "persuade" employees to help save money for the employer.

In reality, no one who wants to keep their job dares not to go where the employer wants them to go for health care services following an injury. Even though the employer does not "order" the employee to go to a specific facility, the employee always goes there anyway. The PPO for SCF has never, in ACS experience, included chiropractic. It has always been limited to PT, MD or DO. Usually, the patients that might have come to a DC are seen at Concentra.

A strong Industrial Commission of Arizona (ICA) could bring this practice of unlawful patient steerage in insured plans to a halt immediately. Patient freedom of choice would be restored, and some percentage of patients would then naturally begin to choose chiropractic care for work injuries. ACS intends to move forward to ask the Industrial Commission to take action. If the agency does not cooperate voluntarily, then further action, up to and including legislation, may have to be considered. ACS also stands for full insurance equality in workers' compensation.
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Therapy Provider, Spinedex Physical
Therapy USA Inc., Files Suit Against
United Healthcare of Arizona Inc.

The Business Journal of Phoenix - by Angela Gonzales   April 18, 2008

A local physical therapy provider has filed a lawsuit against UnitedHealthcare of Arizona Inc. over reimbursement issues on a low-back treatment and other physical therapy services.

The attorney representing the plaintiff, Spinedex Physical Therapy USA Inc., said he will try to have the lawsuit certified as a class action because he believes thousands of patients have been affected in the case.

In its lawsuit filed with the U.S. District Court in Arizona, Spinedex Physical Therapy alleges that UnitedHealthcare is inconsistently paying for some physical therapy services and not for others. The lawsuit was filed on behalf of employee benefit plan participants who receive health insurance benefits through United. Joseph Garofolo, representing Spinedex, said he still needs to "do discovery" but the court still needs to determine whether the lawsuit can be certified as a class action.

"The court has discretion to shape the way the class looks," Garofolo said.

While the amended complaint was filed April 6, defendants have not been served, Garofolo said. He said he hopes to serve them this week.
Cheryl Randolph, a spokeswoman for UnitedHealthcare and its affiliate, Ingenix Inc., said she couldn't comment on the lawsuit except to say, "We believe there is no merit to their allegations, and we will vigorously defend ourselves."

Ingenix, which also is named in the lawsuit, sets reimbursement rates for health care providers. The suit alleges that Ingenix is setting rates too low for out-of-network medical expenses.

The New York Attorney General's Office has been looking into Ingenix for the past several months. The office issued a press release in February announcing its intent to file a lawsuit against Ingenix and its parent, UnitedHealth Group Inc. As of this week, the AG had not filed suit.

"We have been meeting with (New York Attorney General Andrew Cuomo), providing information, and we continue to do that," Randolph said.

She said UnitedHealthcare "stands by the high quality, dependability and integrity of the Ingenix database tools."

Jim Hertel, publisher of the Arizona Managed Care Newsletter, said he is not surprised by the Spinedex lawsuit against United.

"Ever since the New York attorney general began to explore this issue and attack the mechanism that has been established by United's Ingenix unit, along with its use by other carriers, there has been the potential for suits of this nature by consumers insured by the various carriers," Hertel said. "It is interesting to see this suit brought by a provider."

Alan Immerman, president and executive director of the Arizona Chiropractic Society, said he plans to join the lawsuit.

"We expect to be talking to Mr. Garofolo from San Francisco," he said. "We expect he will be advising us as to how we will be able to invite our doctors (to join the lawsuit)."

The society has about 220 members.

"We are not going to stand by and tolerate it when insurance companies deny coverage for care that our patients really need," Immerman said. "We hope this lawsuit sends a message that we are serious."

Get connected

UnitedHealthcare of Arizona Inc.:
Spinedex Physical Therapy USA Inc.:
Arizona Chiropractic Society: 

Reprinted from the Phoenix Business Journal, April 18, 2008

All contents of this site © American City Business Journals Inc.
All rights reserved.

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ACS Adds Special

ACS has a list of "Special Treasures," publications that have been assembled and that are available on request only to ACS Members by email. This list is constantly being updated so check back regularly! The following is a list of the ACS Special Treasures:

1. Personalized advice on how to collect from insurance companies after all of your usual methods have been tried and failed.

2. Arizona Chiropractic Board of Examiners monthly minutes.

3. Dr. Preston Long rebuttal package: Dr. Long is one of the most active defense IME DCs in Arizona. The ACS rebuttal package contains scores of references to journal articles, guidelines from various nations in the world regarding chiropractic, an analysis of the safety of chiropractic, information from the Chiropractic Board regarding Dr. Long and excerpts from Dr. Long's past depositions. If you want to win a battle with Dr. Long, this is the package you need.

4. Timely Payment of Claims, Adjudication and Adjustments: Complete instructions for exactly what to do when insurers do not pay in a timely manner.

5. Record Keeping as Mandated by the Chiropractic Board: ACS has nailed down the most accurate information in Arizona regarding what is required by the Board in terms of record keeping. This includes a sample daily progress note that was approved by the Board's auditor after a chiropractor was disciplined, educated in the Board-approved record keeping class, and audited by the Board-approved auditor.

6. Medical Records Protocol: All chiropractors are required by law to have a proper Medical Records Protocol on file in their offices. ACS retained an expert health care law specialist in 2006 to draft its Protocol which is available to members.

7. Health Care Appeals Process: THE system to follow in Arizona to get medical necessity denials overturned. ACS explains the complicated steps in easy terms so that you can use the program today in your office to increase collections.

8. Grievance Letters: These formal and legal letters are simply the best way to get an insurers' focused attention and to get your bills paid. ACS explains the entire Grievance process and shows you how to incorporate it into your practice.

9. Complete instructions for what to do when an insurer states that your fees are above the usual and customary fee schedule for your area.

10. Complete instructions for how to file a wide variety of complaints against any type of insurance company.

11. Personalized advice regarding whether you should join managed care networks including BCBS PPO, ACN, ASHN and many others. Each practice has its own needs, and ACS can help you determine what will work best in your office.

NEW: 12. Key ERISA self-funded plan tools. When your patient works for a company with more than 500 employees, the health plan is almost always self-insured and exempt from state regulation. Find out how to appeal claims denials from the Arizona Department of Insurance and the U.S. Department of Labor. Learn how you can force ERISA plans to tell you exactly what you need to tell them to get them to pay claims.

NEW: 13. Small Claims and Justice Court Lawsuit Instructions: Some offices have found that filing lawsuits on behalf of patients is an inexpensive an easy way to get your case in front of an impartial judge who will usually rule against an insurance company. Knowing this, almost all insurers will settle when sued according to some doctors. ACS has complete instructions.

NEW: 14. How to Search the National Library of Medicine: The Arizona Chiropractic Board requires that your practice methods be based on peer-reviewed and indexed scientific journal studies. ACS now provides complete instructions for how to access such studies on the Internet by searching the National Library of Medicine. Then, ACS provides a recommendation for a specific medical library to order studies from which is quick, reliable and inexpensive.

NEW: 15. Referrals to ACS' choice of an excellent attorney to represent Chiropractors before the Arizona Chiropractic Board.  ACS has referred dozens of doctors over a period of many years to this attorney, and has only received very positive feedback. This attorney does not advertise to the profession. He does not need to. ACS receives no remuneration or any type of gain for these referrals, other than the satisfaction of knowing that the doctors are receiving fine legal attention.

16. Much more to come! Membership is very valuable! Join today by going to and filling out an application. We will email you the above-listed documents very quickly! You can transform your practice almost overnight.

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ACS Presses ADOI on
Humana and AWHN

Elise Bartlett, Arizona Department of Insurance

April 12, 2008

Dear Ms. Bartlett,

As you can see, the notice below was sent to all ACS members in May of 2007. It was sent after I and many of my members had sent you reams of evidence showing gross mishandling of claims by Humana and its contractor AWHN for which it is responsible.

Now it has been almost a year. In the interim, we have seen the California Departments of Insurance and Managed Care take disciplinary action against many managed care plans and access large fines. ADOI, in contrast, has done nothing. Frankly, some of my members have lost hope that ADOI is ever going to take action to address the obviously inappropriate conduct by Humana and AWHN. Is there any reason at this point for me not to draw this conclusion?

Thank you, as always, for your service and your attention to this pressing matter.

Alan M.  Immerman, D.C., President

Dear Dr. Immerman:
Thank you for your patience in waiting for a response to your April 12, 2008 e-mail. I can certainly appreciate your frustration with the time it is taking the Department to investigate you and your colleagues' concerns with the claims -- handling practices of Humana and its administrator, AWHN.  We are continuing a thorough review. Under ARS 20-158(D), the Department does not disclose any information related to examinations or investigations while they are on-going. When we have concluded an investigation or examination, we can make the final report or other documentation available to anyone who requests it as a public record.   
Your e-mail message also notes that actions have been taken against insurers in California that have involved large fines.  The regulatory authority of the California Department of Insurance and the California Department of Managed Care is completely separate from the authority we have under Arizona law to regulate the insurance practices in our state.  Thus, the action that California (or any other state) takes does not have an impact on what the Arizona Department of Insurance does, even when the same companies are authorized to do business in multiple states.
If you or your association members have new concerns to present to the Department, rather than forwarding them to me directly, please e-mail them to our Provider Information Line at to ensure that not only are they are handled appropriately, but are also accounted for in the area of our Division that assesses patterns and trends in such information.  
Thank you.
Elise Bartlett
Health Insurance Compliance Officer
Life and Health Division
Arizona Department of Insurance
phone: 602-364-2184
fax: 602-364-2715
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